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Tuesday, March 5, 2019

Can medicine be cured? Some views from across the Pond

If you're concerned about where things are headed, this is a compelling read.

At once witty and sobering. Has me re-thinking a few of my own opinions, even as it reinforces a number of others.

Welcome Page
About Can Medicine Be Cured?
Chapter 1. ‘People Live So Long Now’
Chapter 2. The Greatest Breakthrough since Lunchtime
Chapter 3. Fifty Golden Years
Chapter 4. Big Bad Science
Chapter 5. The Medical Misinformation Mess
Chapter 6. How to Invent a Disease
Chapter 7. ‘Stop the Awareness Now’
Chapter 8. The Never-Ending War on Cancer
Chapter 9. Consumerism, the NHS and the ‘Mature Civilization’
Chapter 10. Quantified, Digitized and for Sale
Chapter 11. The Anti-Harlots
Chapter 12. The McNamara Fallacy
Chapter 13. The Mendacity of Empathy
Chapter 14. The Mirage of Progress
From the Amazon blub:
A fierce, honest, elegant and often hilarious debunking of the great fallacies that drive modern medicine.

'A deeply fascinating and rousing book' Mail on Sunday.

'What makes this book a delightful, if unsettling read, is not just O'Mahony's scholarly and witty prose, but also his brutal honesty' The Times.

Seamus O'Mahony writes about the illusion of progress, the notion that more and more diseases can be 'conquered' ad infinitum. He punctures the idiocy of consumerism, the idea that healthcare can be endlessly adapted to the wishes of individuals.

He excoriates the claims of Big Science, the spending of vast sums on research follies like the Human Genome Project. And he highlights one of the most dangerous errors of industrialized medicine: an over-reliance on metrics, and a neglect of things that can't easily be measured, like compassion.
Indeed. to wit,
14: The Mirage of Progress

Progress – rather than compassion – is the core belief of the medical–industrial complex. The philosopher John Gray wrote that ‘questioning the idea of progress at the start of the twenty-first century is a bit like casting doubt on the existence of the Deity in Victorian times’. The belief in progress reflects the power of science to change our lives. Over the last one hundred years, longevity has increased dramatically, and immunization has reduced or eradicated diseases that used to kill millions of people. The benefits of science seem so self-evident that only a fool or a madman would question it, or the idea of progress. But science, which gave us all these unalloyed benefits, also gave us nuclear bombs and napalm; it is entirely possible that technology may render the world uninhabitable for humans. Then, progress will end. John Gray has never denied the reality of scientific progress, or its benefits, but has consistently argued that although scientific knowledge increases from generation to generation, gains in ethics and politics are more easily lost: ‘They have to be learned afresh with each new generation.’…
[Kindle edition location 2696]
One nice attribute of this book is that you need not read it in chapter order. My path thus far has been that of introductory material, Chapter 1, Epilogue, 14, 13, 12, 10, 5, 2, and 3 (some of it driven by my frequent cut-to-the-chase keyword/phrase searching).

Seamus is not a big fan of Eric Topol, nor Bertalan Mesko, btw.
Eric Topol views doctors like me as the chief professional obstacle to digital health: ‘Half of American physicians are over age fifty-five, far removed from digital native status (under age 30).’ Topol (sixty-four), with his 2.8 million Instagram followers, is the disco-dancing dad of digital health. The self-styled ‘medical futurist’, the Hungarian Bertalan Meskó, is Topol’s ideal digital native doctor: ‘Since the age of fourteen, I have been logging details of my life every single day. It means not one day is missing from my digital diary which now consists of over 6,600 days with data.’ Like Topol, he argues that ‘the ivory tower of medicine is no more’, and that ‘patients, now called e-patients or empowered patients, who are ready to hack and disrupt healthcare need guidance.’... [Kindle location 1962]
Yikes. Ahhh... "Futurists."

Update: Below, I am reminded of this book, from a 2012 post:

"Slow Medicine"
See also my recent post "Overcharged?"


On my way to OAK airport recently to pick Cheryl up, I heard a KQED Forum segment whose guest was Benjamin Dreyer, Copy Chief at Random House. They discussed his new book:

I bought it. I'm a pretty fair writer, but this book will help me improve significantly. Very witty and informative. It's giving me some recurrent SMH "Edwin Newman Moments."

They discussed the nexus between "critical thinking" (which I've taught) and clear oral and written prose. Yep. Would that I take my own advice more often.

"Most of the diseases that kill us now are caused by, and associated with, ageing. We just wear out. Dementia, heart disease, stroke and cancer kill us now, not smallpox and Spanish flu. Medicine can still pull off spectacular rescues of mortally sick young people, but these triumphs are notable for their relative rarity. The other flaw in the Big Science theory is that a great deal of what is laid at medicine’s door to fix has nothing to do with malfunction of the machine; much of the work of GPs is helping people cope not with disease but with living problems, or ‘shit life syndrome’, as some call it…

…Research, unfortunately, will never help most of what ails mankind: growing old and dying. These are eternal human verities, but we expect medicine to somehow solve this riddle. Epidemiologists and public health doctors would argue that medicine now contributes little to health in developed countries, and that poverty, lack of education and deprivation are now the main drivers of poor health. This is almost certainly true. Although vaccination and antibiotics contributed significantly to the increase in human longevity in the mid-twentieth century, medical care now has little direct influence on the health of a population, accounting for only about 10 per cent of variation. Furthermore, some have argued persuasively that if we were to simply apply evenly and logically what research has already proven, health care would be transformed..."
[Kindle locations 532 & 561]
I'd better leave it that, in terms of "Fair Use." You should buy this book. Seamus' book is a veritable abattoir of clinical Sacred Cow Herd demise.

BTW, Dr. O'Mahony wrote an earlier book that is not available electronically.


Jus' sayin'.

More to come...

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